Making the decision to move an older person from their home to a place where they can live safely is a tough choice for all involved. A move to an assisted living facility is one option. These facilities provide care for people who need services such as medication reminders, meals, transportation, and some assistance with activities of daily living, like bathing and dressing.
Why might a person resist moving to a place where they can get help with daily activities?
Fear is a common reason. Home has a deep symbolic meaning for most people, representing safety, security, and identity. People work hard all their lives for their home and the thought of leaving home is something that people resist.
Control is a major factor. As people age, the losses pile up. Many people want to preserve whatever control over lives that they can, and sometimes that control means exercising their right to make a choice. So, they're going to refuse to move even though they may greatly benefit from assisted living.
Outdated notions of what life is like in an assisted living facility can also be an issue. Maybe your loved one knows someone who had a bad experience in an assisted living facility. Maybe they think that nursing homes and assisted living facilities are one and the same, not realizing that many places offer care and amenities unheard of in the past.
Concerns about money can play a role. Many people believe that Medicare will pay for long-term care in an assisted living facility and then are shocked to learn that it doesn’t. Medicaid isn’t an option either. Assisted living facilities in Tennessee won’t accept this public benefit. As a result, a resident must pay for care out of pocket. The monthly cost can be quite high, with rates in Nashville averaging $4,925 per month.[1]
No matter why a person is resisting a move, waiting too long can have serious consequences.
Though waiting too long typically doesn’t directly cause legal problems, a person who may be resistant to moving may also be the type of person to put off creating the estate planning documents that everyone needs (Will or Trust, Financial Power of Attorney, Advance Directive for Healthcare). This procrastination can create many legal headaches for family caregivers.
Consider the Power of Attorney and Advance Directive for Healthcare, two essential estate planning documents where a person names the individuals they authorize to make financial and medical decisions for them in the event they are incapacitated. Anyone who puts off creating these documents and they later become incapacitated is unable to give anyone that authority. This creates legal problems that family caregivers will have to solve. The solution often comes in the form of petitioning the court for guardianship and conservatorship over the elderly relative, legal procedures that are difficult, costly, public, and the source of much conflict.
The irony here is that saying no is a way that many older adults preserve some sense of control. However, saying no to creating estate planning documents guarantees that the older adult will have NO say in life-altering decisions once they lose capacity. An older adult who puts off creating these documents and then no longer has the capacity to execute them gives up the ability to choose which facility they want to live in. They also lose the ability to choose who gets to make financial and healthcare decisions for them.
Saying no to assisted living again and again can also have care-related consequences. An older person who is struggling to manage the activities of daily living today isn’t going to find those tasks any easier to manage tomorrow, next month, or next year. Waiting too long often means that the older adult’s needs increase to the point where assisted living is no longer an option. From a mobility and cognitive standpoint, if an older adult waits too long, he or she might not meet the admission criteria for assisted living. For these folks, waiting too long amounts to a one-way ticket to a nursing home.
There are also social consequences. An older adult living alone at home often lacks the opportunity for interaction with others. This makes them more vulnerable to isolation, loneliness, and depression, all of which can hasten physical and mental decline.
And then there’s the impact on family caregivers. In many cases, it’s the spouses, sons, daughters, and grandchildren who are picking up the slack, turning themselves inside out to allow their loved ones to live “independently” at home. That independence is usually an illusion however, and eventually, even the most patient and well-meaning family caregivers will buckle under the pressure. These situations are often the source of much conflict in families.
If you’re an adult child or family caregiver who is looking after a loved one who is resisting a move to assisted living, what can you do?
Do Your Homework
First, use your favorite search engine to compile a list of assisted facilities in your loved one’s area. Find out as much as you can about each one, and then identify two or three that look promising. “The elder care coordinators at Takacs McGinnis Elder Care Law are familiar with the assisted livings in the area and can be a resource to help families find the right fit,” said Outreach Coordinator Dana Hentschel. “Additionally, there are local placement agencies that help families find the right facility for their loved one at no cost to the family.”
Tour the facilities you like best, then have lunch at each on—without your elderly loved one first. After all, you’re doing recon. Interact with the staff and residents to get a feel for what it’s like to live there and work there. After you have visited each facility, create a short summary of how the facilities compare.
Talk to Your Loved One
Sit down with your loved one and start asking questions. Be curious. Try to find out what’s behind the resistance. What are they afraid of losing? What might they gain by making such a move? What are their objections? Don’t interrupt. After you have heard them out, take a break from the conversation and think about what they said. Consider each objection. See if you can find a way to mitigate it in some way. Once you have a plan, visit your loved one again to share your thoughts.
Tour Assisted Living Facilities
If your loved one is open to looking at assisted living facilities, arrange to tour the places you liked most, this time with your loved one. All the same things you did during your data-gathering tour, do with your loved one.
Use Short-Term Respite as a Trial
Many assisted living facilities offer short-term respite care, anywhere from a weekend to a few weeks. This is a great way for an older adult to experience life in the facility. If your loved one is open to it, arrange for a respite stay. In many cases, people who initially resisted the idea of assisted living warm to it after a respite stay. It’s worth a try.
Know going in that your loved one may still say no to assisted living, even after you’ve taken all the steps outlined above. If your loved one is of sound mind, you can’t force them. However, you might benefit from help from professionals who work with situations like these every day. Elder Care Coordinator Katlyn Green urges clients to seize the opportunity to experience the quality of life that assisted living can offer. “Waiting increases the risk that their loved one might not get the full enjoyment,” she said. “No care is free, so why not get the most bang for your buck while you can participate?"
At Takacs McGinnis Elder Care Law, we specialize in helping older adults and their family caregivers navigate the challenges of aging. If you’re interested in learning more, give us a call at 615.824.2571 to schedule a consultation.